We all saw firsthand how quickly a disease you've never heard of in a place you may have never been can become a public health emergency right in your own backyard. Viruses like COVID-19 remind us that, for all our differences, everyone in this world is connected biologically by a microscopic network of germs and particles – and that, like it or not, we're all in this together. We hope the experience we've all lived through over the last year will lead to a long-term change in the way people think about global health – and help people in rich countries see that investments in global health benefit not only low-income countries but everyone. We were thrilled to see the United States include $4 billion for Gavi in its latest COVID-19 relief package. Investments like these will put all of us in a better position to defeat the next set of global challenges.
我们亲眼见证了这样一幕:一种你闻所未闻的疾病在某个你或许从未踏足的地方暴发,迅速地形成一场你身边的公共卫生紧急事件。像新冠肺炎这样的病毒提醒着我们,无论我们有多么不同,从生物学的角度来看,世界上的每个人都被微生物和微粒组成的微观网络紧紧相连——无论你愿不愿意接受,我们都在一条船上。我们希望去年一起走过的经历能深远地改变人们对全球健康的看法,也让富裕国家的人们看到,对全球健康的投资不仅能惠及低收入国家的人民,更能让所有人受益。我们非常兴奋地看到美国最新的新冠肺炎援助计划涵盖了一项40亿美元的投入,用于支持全球疫苗免疫联盟。这类投资能让我们在应对下一次全球挑战时准备得更好。
Just as World War II was the defining event for our parents' generation, the coronavirus pandemic we are living through right now will define ours. And just as World War II led to greater cooperation between countries to protect the peace and prioritize the common good, we think that the world has an important opportunity to turn the hard-won lessons of this pandemic into a healthier, more equal future for all.In the rest of this letter, we write about two areas we see as essential to building that better future: prioritizing equity and getting ready for the next pandemic.
正如第二次世界大战是我们父母那一代的决定性事件,我们正在经历的这场新冠肺炎疫情也将重新定义我们这代人的生活。二战促使各国加强合作,维护和平、实现共同利益。现在,我们也有机会将应对这场疫情危机中来之不易的经验教训转化成一个人人更加健康和平等的未来。在接下来的内容中,我们将阐述对构建一个更加美好未来至关重要的两个领域:优先解决公平问题,和为下一场大流行病做好准备。
Can we emerge from this pandemic more equal than we entered it?
疫情结束时,我们在公平问题上能比以前有所进步么?
Melinda: One of the things I've missed most over the last year is traveling to see our foundation's work in action. I have photos all over our house of the women I've met on these trips. Now that I'm working from home, I see their faces all the time.
梅琳达:过去一年我最怀念的事情就是去实地看看我们基金会的工作情况。我家到处都能看到我在这些旅程中遇见的女性的照片。即使现在在家办公,我也能时常看到她们的面孔。
I often wonder what the pandemic looks like through their eyes and how they're coping. When I'm on videocalls with experts and world leaders, I try to imagine how the decisions being made in these conversations will affect these women and their families. They're a daily reminder of the importance of ensuring that the world's COVID-19 response leaves no one behind.
我常常在想她们眼中的疫情是怎样的,她们又在如何应对。在与世界各地的专家和领导者视频通话时,我也会想象这些对话中做出的决策将如何影响这些女性和她们的家人。她们时刻提醒我,在新冠疫情的全球应对行动中不能让任何人掉队。
From AIDS to Zika to Ebola, disease outbreaks tend to follow a grim pattern. They hurt some people more than others – and who they hurt most is not random. As they infect societies, they exploit pre-existing inequalities.
从艾滋病到寨卡病毒再到埃博拉,这些疾病的暴发都呈现出一种残酷的模式。它们对一些人的伤害远大于其他人,而受到最大冲击的往往是同一群人。在它们影响整个社会的同时,还会加剧原本就已存在的不平等。
The same is true of COVID-19. People with less are faring worse than those with more. Essential workers are facing greater risks than those who can work from home. Students without internet access are falling behind students who are learning remotely. In the United States, communities of color are more likely to get sick and die than other Americans. And all around the world, women who have been fighting for power and influence over their lives are seeing decades of fragile progress shattered in a matter of months.
新冠肺炎造成的影响也是如此。资源匮乏的人群比资源丰沛的人群受到疫情的冲击更大;关键岗位的工作人员比可以居家办公的人面临更大风险;无法上网的学生比能够远程学习的学生在课业上落后更多。在美国,有色人种的患病和死亡率都更高。而在世界各地,那些一直在为生命的权力和影响力而抗争的女性眼看着过去几十年取得的微小进步在短短几个月内便付之一炬。
From the beginning of the pandemic, our foundation has worked with partners in the United States and around the world to address the uneven social and economic impacts of COVID-19 and keep those pre-existing inequalities from growing deeper.
盖茨基金会自疫情伊始便与美国及世界各地的伙伴通力协作,应对新冠肺炎对社会和经济造成的不平等,并阻止早已存在的不平等问题进一步加剧。
In the United States, many of our anti-COVID efforts overlap with our work on racial equity. For example, the data tell us that Black Americans are three times as likely as white Americans to get COVID-19, and they are also more likely to live in an area with limited access to COVID-19 testing. To help meet the demand for local community testing, our foundation partnered with historically Black colleges and universities to expand diagnostic testing capacity on their campuses.
在美国,我们在抗击新冠疫情方面的很多努力与我们推动种族平等的工作息息相关。例如,数据显示,美国黑人感染新冠肺炎的几率是白人的三倍,并且他们更有可能生活在缺乏新冠肺炎检测能力的地区。为满足当地社区的检测需求,盖茨基金会与传统黑人学院和大学合作,提高校园内的新冠诊断检测能力。
We're also addressing the pandemic's disproportionate impact on people of color in other ways, including through our foundation's U.S. education work. We're concerned about students falling behind at all levels (when schools closed last spring, the average student lost months of learning), but we're especially troubled that COVID-19 could exacerbate long-standing barriers to higher education, particularly for students who are Black, Latino, or from low-income households. Median lifetime earnings of college graduates are twice those of high school graduates, so the stakes for these young people are high. To help students navigate COVID-19 roadblocks, our foundation expanded our partnerships with three organizations that have a proven track record of using digital tools to help students stay on the path to a college degree. We think the models and approaches these organizations are honing now will continue to expand opportunities for students post-pandemic, too.
我们还通过其他方式,包括基金会在美国教育领域的工作,应对疫情对有色人种造成的不平等影响。我们担心各个年级的学生都可能落下课业(去年春天学校停课时,学生平均失去了几个月的学习时间),但我们尤其担心新冠疫情会加剧高等教育中长期存在的壁垒,特别是对于黑人、拉丁裔和来自低收入家庭的学生。大学毕业生终生收入的中位数是高中毕业生的两倍,因此这一问题会对这些年轻人产生深远的影响。为帮助学生克服新冠疫情造成的阻碍,盖茨基金会扩大了与三个组织的合作关系,它们一直以来都在利用数字工具帮助学生坚持学习并取得大学学位。我们认为这些组织正在探索的模式和方法会在疫情后继续为学生们带来更多机会。
When it comes to our work outside the United States, my major focus has been calling on world leaders to put women at the center of their COVID-19 response. If governments ignore the fact that the pandemic and resulting recession are affecting women differently, it will prolong the crisis and slow economic recovery for everyone.
谈到美国以外的工作,我的主要工作重点是呼吁世界领导人在应对新冠疫情时应重点考虑女性。这场疫情和由其造成的衰退对女性的影响更大。如果政府忽略这个事实,这场危机还会进一步延长,经济复苏的延缓也势必影响每一个人。
For example, because of the economic shutdowns over the last year, hundreds of millions of people in low-income countries have needed help from their government to meet basic needs. But the cruel irony is that the women who most need these economic lifelines tend to be invisible to their governments. It's hard to send cash safely and swiftly to a woman who doesn't appear in the tax rolls, have a formal identification, or own a mobile phone. Unless financial systems are specifically designed to include these women, these systems are likely to exclude them, pushing them even further to the economic margins. Our foundation has worked with the World Bank to help countries overcome these hurdles and create digital cash transfer programs with women's needs in mind.
例如,由于去年经济停摆,低收入国家的数亿人口需要政府的帮助才能勉强度日。但讽刺的是,政府常常会对最迫切需要这些经济援助的女性视而不见。向没有缴税记录、缺少正式身份证明,或没有手机的女性安全快捷地转账汇款非常困难。除非这些金融系统是专门为女性设计的,否则很可能忽视她们的需求,将她们进一步推向经济体系的边缘。我们的基金会还与世界银行合作,帮助各国克服障碍,建立起真正考虑到女性需求的数字转账项目。
More broadly, we're supporting efforts to design economic response plans targeted at women and low-wage workers. In low- and middle-income countries, the poorest people tend to be self-employed in the informal sector – as farmers or street vendors, for example. Policymakers often overlook these workers, and traditional stimulus measures don't meet their needs. (Tax rebates don't really help people who don't pay taxes – and who pays for your paid leave if you work for yourself?) Our foundation helped fund research into how governments can repair these holes in the safety net by prioritizing measures like cash grants, food relief, and moratoriums on rent and utilities.
从更广泛的意义上说,我们正在支持设计针对女性和低收入工作者的经济应对计划。在中低收入国家,最贫穷的人通常是非正规部门的个体经营者,例如农民或街头小贩。政策制定者常常忽视这些人,而传统的经济刺激措施也无法满足他们的需求。(税费减免措施无法帮助那些不纳税的人,而给自己打工的人又如何实现带薪休假呢?)盖茨基金会也在资助研究政府如何通过优先采取现金资助、食品救济与延付租金和水电费等措施,来修补社会保障体系中的漏洞。
This past year has also shined a spotlight on women's unpaid labor, an issue I've written about in this letter before. With billions of people now staying home, the demand for unpaid care work – cooking, cleaning, and childcare – has surged. Women already did about three-quarters of that work. Now, in the pandemic, they've taken on even more of it. This work may be unpaid, but it comes at an enormous cost: Globally, a two-hour increase in women's unpaid care work is correlated with a 10 percentage point decrease in women's labor force participation. As governments rebuild their economies, it's time to start treating child care as essential infrastructure – just as worthy of funding as roads and fiber optic cables. In the long term, this will help create more productive and inclusive post-pandemic economies.
去年,女性无偿劳动成为人们关注的焦点,我在过去的年信里也谈到了这个问题。现在,几十亿人都隔离在家,对做饭、打扫、育儿等无偿护理工作的需求激增。女性已经承担了其中四分之三的工作。疫情之中,她们肩上的担子更重了。这类工作虽然是无偿的,但却要付出巨大的代价:全球范围内,女性无偿护理工作每增加2小时,就会使得女性劳动参与率降低10%。在政府重振经济之时,我们也应该开始将育儿视作一项重要的基础设施,像修建道路和铺设光缆一样值得资助。长远看来,这有利于创建更具生产力和包容性的后疫情经济。
Bill and I are deeply concerned, though, that in addition to shining a light on so many old injustices, the pandemic will unleash a new one: immunity inequality, a future where the wealthiest people have access to a COVID-19 vaccine, while the rest of the world doesn't.
然而,比尔和我最为担心的是,这场疫情不仅会暴露很多已经存在的不平等,还会引发一个全新的问题:免疫不平等,即未来只有最富裕的人可以接种新冠肺炎疫苗,而其他人却无法接种。
Already, wealthy nations have spent months prepurchasing doses of vaccine to start immunizing their people the moment those vaccines are approved. But as things stand now, low- and middle-income countries will only be able to cover about one out of five people who live there over the next year. In a world where global health is local, that should concern all of us. From the beginning of the pandemic, we have urged wealthy nations to remember that COVID-19 anywhere is a threat everywhere. Until vaccines reach everyone, new clusters of disease will keep popping up. Those clusters will grow and spread. Schools and offices will shut down again. The cycle of inequality will continue. Everything depends on whether the world comes together to ensure that the lifesaving science developed in 2020 saves as many lives as possible in 2021.
富裕国家早在数月之前就已经开始大量预购疫苗,确保这些疫苗获批后能立即为其公民接种。从目前状况看来,中低收入国家在未来一年内只能为其五分之一的人口提供疫苗。在一个全球健康与本土健康融为一体的世界中,我们每个人都应该为此深感担忧。从疫情开始,我们就在提醒富裕国家谨记一点:任何一处的新冠疫情都会对整个世界构成威胁。在每个人都能接种疫苗之前,还会有一批批病患不断出现。这些病患群体会扩大、蔓延。学校和企业会再度停工停学。不平等的恶性循环也将持续下去。一切都取决于全世界能否齐心协力,保证2020年取得的科学成果能在2021年尽可能挽救更多生命。
Existential crises such as these leave no facet of life untouched. But solutions that are worthy of these historic moments also have ripples. Demanding an inclusive response will save lives and livelihoods now – and create a foundation for a post-pandemic world that is stronger, more equal, and more resilient.
此类关乎人类存亡的危机会影响生活的方方面面。而随着这些历史性时刻应运而生的解决方案也必将产生涟漪效应。包容性的应对措施不仅能挽救生命、改善生计,还能为建设一个更强大、更平等、更坚韧的后疫情世界打下坚实的基础。
It's not too soon to start thinking about the next pandemic.
防范下一场大流行病,并非言之过早。
Bill: One of the questions I get asked the most is when I think the world will get back to normal. I understand why. We all want to return to the way things were before COVID-19. But there's one area where I hope we never go back: our complacency about pandemics.
比尔:我被问到最多的一个问题是世界何时会恢复正常。我理解为什么大家会问这个问题。我们都想回到新冠疫情之前的世界。但是有一个领域我希望我们永远不要回到过去,那就是我们对于大流行病的轻敌自满。
The unfortunate reality is that COVID-19 might not be the last pandemic. We don't know when the next one will strike, or whether it will be a flu, a coronavirus, or some new disease we've never seen before. But what we do know is that we can't afford to be caught flat-footed again. The threat of the next pandemic will always be hanging over our heads – unless the world takes steps to prevent it.
残酷的现实是,新冠疫情恐怕不会是我们面临的最后一场大流行病。我们不知道下一次疫情何时到来,也不知道它是一种流感、冠状病毒还是其他前所未见的新疾病。但我们必须做好准备,不能再被打得措手不及。除非全世界行动起来,防患于未然,否则下一场大流行病的威胁依然会笼罩人类。
The good news is that we can get ahead of infectious disease outbreaks. Although the world failed to prepare for COVID-19 in many ways, we're still benefiting from actions taken in response to past outbreaks. For example, the Ebola epidemic made it clear that we needed to accelerate the development of new vaccines. So, our foundation partnered with governments and other funders to create the Coalition for Epidemic Preparedness Innovations. CEPI helped fund a number of COVID-19 candidates – including the Moderna and Oxford AstraZeneca vaccines – and is deeply involved in the vaccine equity work that Melinda wrote about.
所幸,我们可以在传染病暴发前未雨绸缪。尽管世界在很多方面都没能为新冠疫情做好充足准备,但我们依然受益于过去抗击其他传染病的经验。例如,埃博拉疫情让我们认识到需要加速新疫苗的研发。因此,盖茨基金会与政府和其他资助者合作,创立了流行病防范创新联盟(CEPI)。CEPI资助了多个新冠候选疫苗的研发,包括Moderna研发的疫苗以及牛津大学与阿斯利康(AstraZeneca)合作研制的疫苗。CEPI也深度参与了梅琳达提到的疫苗公平分配的工作。